Introduction:

Myositis is a term given to a cluster of rare autoimmune conditions. It is a progressive, chronic inflammation of the muscles. Some myositis types cause skin rashes, while others can affect the ability of a person to swallow food. The condition can be managed with regular exercise and medications; however, figuring out the right treatment requires time.

Types of myositis

The various types of myositis are as follows:

• Dermatomyositis: It affects multiple muscles at a time and causes a rash initially. Typically seen in women but can also be seen to occur in children, which is known as juvenile dermatomyositis. Symptoms include:

Ø Fatigue

Ø Muscle pain

Ø Joint inflammation and pain

Ø Weight loss

Ø Irregular heartbeat

• Polymyositis: Affects different muscle groups such as the shoulders, thigh and hip muscles. Common in women and affects those who are aged 30 to 60 years old. Symptoms include:

Ø Chronic dry cough

Ø Trouble swallowing

Ø Muscle weakness

Ø Hoarse voice

Ø Thickening of the skin on hands

• Inclusion body myositis (IBM): Causes weakness in one’s forearms muscles, thigh muscles and muscles below the knees. IBM can also cause issues with your ability to swallow. This is known as dysphagia. Commonly seen to occur in men and can affect those who are over 50. Symptoms include:

Ø Reduced deep tendon flexes

Ø Muscle pain

Ø Loss of balance

• Juvenile Myositis: Occurs in children below 18 years of age and is marked by skin rashes and muscle weakness.
• Toxic Myositis: Caused by illicit drugs and prescription medications. This is a very rare type and the symptoms of toxic myositis are similar to other myositis types.

The hallmark of polymyositis is a progressive disease with symmetric involvement of proximal girdle muscles (shoulder and pelvis muscles) and neck flexors that can be painful at times.[2] Hip extensors can be involved in some patients making it difficult for them to climb stairs or to have posture change.

Dr. M.G. Kartheeka, MBBS, MD

Causes and risk factors of myositis

Causes

The exact reason for polymyositis is not known, but the disease has much in common with autoimmune conditions in which the immune system mistakenly starts to attack the body tissues. However, some experts believe myositis can be caused due to following:

• Drug toxicity
• Viruses that include the flu, common cold and HIV.
• Autoimmune conditions- lupus, rheumatoid arthritis.

Risk factors

The risk of polymyositis is higher if one has the following conditions:

• Lupus
• Rheumatoid arthritis
• Sjogren’s syndrome
• Scleroderma

Symptoms of myositis

The symptoms of myositis you are likely to experience are based on the type you have. Overall, the following is a comprehensive list of symptoms across the different myositis types.

• Fatigue
• Bumps over the elbows, knuckles and knees with raised, scaly breakouts
• Weakness in hip, back, neck and shoulder muscles
• Lumps (of calcium) under the skin
• Gastrointestinal ulcers
• Trouble getting up from a seated position
• Difficulty walking
• A weakened hand grip
• Fever
• Trouble with motor functions
• Stomach aches
• Irritability or moodiness
• Weight loss
• Muscle weakness

Although there is no cure for myositis, management of the disease is crucial in order to reduce inflammation and to prevent muscle weakness from progressing. It is recommended to follow lifestyle changes so that an individual with myositis can restore his/her strength

Dr. Ashish Bajaj, M.B.B.S., M.D.

Possible complications

Complications that arise as a result of polymyositis include:

Aspiration pneumonia

The trouble with swallowing can lead you to breathe liquids or foods, including saliva, into the lungs (aspiration), which leads to pneumonia

Swallowing difficulties

When the muscles in the oesophagus are affected, a person can experience problems with swallowing. The inability to eat properly can, over time, lead to malnutrition and unhealthy weight loss.

Breathing issues

If the chest muscles are impacted by the disease, then a person can experience breathing issues such as respiratory failure or shortness of breath.

How is myositis diagnosed?

Diagnosing myositis can be tricky because the primary symptoms of the condition are fatigue and muscle weakness. Doctors may ask you to carry out any or a combination of the following tests:

• Physical examination
• Nerve conduction study
• Muscle biopsy
• Electromyography (EMG)
• Magnetic resonance imaging
• Blood tests
• Genetic testing
• Antinuclear testing
• Antibody panel blood test

The speciality of doctor who can diagnose and treat myositis- Rheumatologist 

Treatment of myositis

There is no specific medically approved course of treatment for myositis. Consult with your rheumatologist for the most appropriate treatment path for you. This can include immunosuppressants, physical activities, stretching, exercise and yoga to keep the muscles flexible and strong.

• Exercise: Exercising can reduce swelling, the power you up with more energy and restore or help you to develop muscle endurance. Further, physiotherapy and exercise are highly recommended if you have the condition inclusion of body myositis. Speak to your doctor before getting into any physical activity.
• Lifestyle Management: Like every autoimmune condition, people with myositis must also make healthy lifestyle choices like- 

1. Avoiding excessive salt, sugar and oily food. 
2. Munching on more healthy options- fresh fruits, veggies and nuts (omega-3 fatty acids).
3. Keeping away from tobacco, alcohol and stress.
4. Managing stress 
5. Yoga and mindfulness
6. Good sleep routine

• Immunosuppressants: This is the primary group of medications used to manage dermatomyositis and polymyositis. Helps to alleviate muscle pain and reduce swelling right away.
• Immunoglobulin therapy: Immunoglobulin therapy stops the muscles from attacking the muscles. This involves injecting healthy antibodies from one’s donated blood.
• Depending on overall work, up doctor may plan a prescription with newer drugs like monoclonal antibodies, anti-rheumatoid drugs and other medications.

Key takeaway

• A rare group of autoimmune conditions affecting the muscles.
• Mainly five types of myositis.
• The exact cause of myositis is not known.
• Primary symptoms of myositis are similar to other conditions making diagnosis difficult.
• Exercise and prescribed medications can help manage myositis.

Conclusion

As of now, there isn’t any cure for myositis. The only way to treat it and keep symptoms on a low is with exercise and medications. Consult a doctor if you notice any usual symptoms and have patience with respect to your treatment. It is important to follow up regularly with a rheumatologist to avoid serious complications. You may also join support groups to know how other people are dealing with myositis.

Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.